CNS ADHD/Seizures

Question 1

What are the non-pharmacological treatments for Attention-Deficit/Hyperactivity Disorder?

Answer 1

Psychotherapy, Behavior management, Family support

Question 2

Name two pharmacological treatments for Attention-Deficit/Hyperactivity Disorder.

Answer 2

Methylphenidate (Ritalin), Dextroamphetamine (Adderall)

Question 3

MOA of methylphenidate and dextroamphetamine?

Answer 3

Thought to block reuptake and increases norepinephrine and dopamine at synaptic site to bind to receptors

The exact mechanism is generally unknown.

Question 4

List some side effects of methylphenidate and dextroamphetamine.

Answer 4

• Nervousness
• Insomnia
• Anorexia
• Tachycardia
• Headache
• Weight loss

Question 5

What are the adverse effects associated with the use of ADHD medications?

Answer 5

• Aggressive Behavior
• Abuse
• Pancytopenia (low RBC, WBC, and platelets)

Question 6

What are some causes of seizures?

Answer 6

• Increased intracranial pressure
• CNS infection
• Head trauma
• Withdrawal from barbiturates or alcohol
• Severe hypoxia
• Hypoglycemia

Question 7

What distinguishes partial seizures from generalized seizures?

Answer 7

Partial seizures impact one side of the brain, while generalized seizures impact both sides.

Question 8

What is Status Epilepticus?

Answer 8

State of repeated or continuous seizures lasting more than 20 minutes, deemed a medical emergency

Question 9

What medication is a barbiturate used as an anticonvulsant?

Answer 9

Phenobarbital (Luminal)
controlled substance II, III, IV

Question 10

What are the side effects of phenobarbital?

Answer 10

• Moderate sedation
• Drowsiness
• Lethargy
• Paradoxical restlessness
• Rash
• Urticaria (hives)
• Nausea & vomiting
• Teratogenic

Question 11

What is the action of phenytoin (Dilantin)?

Answer 11

Reduces spontaneous electrical impulses in the brain by blocking sodium action potentials

This mechanism is crucial for controlling seizures.

Question 12

List the side effects of phenytoin.

Answer 12

• CNS: mental confusion, slurred speech
• GI: Gingival hyperplasia
• CV: Severe hypotension & cardiac dysrhythmias (IV)
• Derm: Toxic epidermal necrolysis (TEN), Stevens-Johnson Syndrome (SJS)
• Hemat: Thrombocytopenia, agranulocytosis, pancytopenia
• Teratogenic

Close monitoring is required due to serious potential effects.

Question 13

What are the nursing considerations for patients taking phenytoin?

Answer 13

• Thorough skin assessment
• Assess BP
• Monitor labs (complete blood count, liver function tests)
• LOC
• Drug blood levels

These considerations help ensure safe and effective treatment.

Question 14

What is the action of levetiracetam (Keppra)?

Answer 14

Action is unknown; may interfere with sodium, calcium, potassium, or GABA transmission

Its exact mechanism is still under investigation.

Question 15

What are the side effects of gabapentin?

Answer 15

• CNS: Suicidal thoughts, behavioral changes, dizziness, somnolence, CNS depression, ataxia
• Derm: Drug reaction with Eosinophilia and Systemic Reaction (DRESS)

Question 16

What are the indications for benzodiazepines like diazepam and lorazepam?

Answer 16

• Status epilepticus
• Treatment of epilepsy

They are often used as first-line agents in emergencies.

Question 17

What should patients be taught regarding benzodiazepines?

Answer 17

• Take regularly at the same time each day
• Take with meals
• Journal response to medications
• Wear a medical alert tag or ID
• Do not drive until seizure-free for 3 months
• Do NOT discontinue abruptly